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CSG SK-SSL-BOX-23 David L Buxton 01/20/16 13:35 PAGE I <br /> Safety-Kleen Systems, Inc. <br /> 2600 H Central Expy, Suite 200 <br /> Richardson, TK 75080 <br /> CORPORATE: 800-669-5740 <br /> 24 HR EMERGENCY: 800-468-1760 (Safety-Kleen) <br /> 2095451011 <br /> REFERENCE N3R. <br /> CUSTONER4 LK00044 Lkq 69106965 <br /> 2041 Navy Dr SRVC WEEK: 2016-4 <br /> Attn Jerry SRVC DATE: 01/20/16 13:33 <br /> Stockton CA 95206-1142 <br /> PHONE 209-464-1111 <br /> HILL TO CUSTOMER# BILL TO ADDRESS: <br /> LKOD044 Lkq <br /> 2041 Navy Dr <br /> Attn .Ferry <br /> Stockton CA 95206-1142 <br /> PHONE 209-464-1111 <br /> PURCHASE ā¯‘RDERA TAIL EXEMPT# <br /> PRODUCTISERVICES <br /> SERVICE/ TOTAL <br /> PRODUCT QTY UNI= PRICE TAX CHARGE <br /> 90837 MODEL 90 W12387 6 6365 1.000 316.0500 28.44 344.49 <br /> SIN 116982 TAG TOOOOo0OXX90209571 CLEAN 3.00 SPENT 0.000 <br /> SERVICE TERM 12 WEEK SCANNED YES <br /> 100001 FEE, FUEL SURCHARGE 1.900 9.8600 0.89 10.75 <br /> ----------------------------------------- <br /> TOTAL SERVICE/PRODUCTS 325.9100 29.33 355.24 <br /> TOTAL CHARGE 355.24 <br /> CREDITS 0.00 <br /> TOTAL DUE 355.24 <br /> UNPAID BALANCE THIS RECEIPT 355.24 <br /> Machine clean and good condition? Yes <br /> Lamp Assembly Condition Yes <br /> Decals in place and legible? Yes <br /> Fusible link installed? Yes <br /> Emergency closing of lid unobstructed? Yes <br /> Machine properly grounded? Yes <br /> Local Phone No. Sticker Affixed to Machine Yes <br /> Spent solvent meets acceptance criteria? Yes <br /> GENERATOR STATUS <br /> 0-220 lbs/month <br /> Customer certifies that (i) the above-named materials are properly <br /> classified, packaged, marked and labeled, and are in proper condition <br /> for transportation according to the applicable regulations of the <br /> Department of Transportation and (ii) no material change has occurred <br /> either in the characteristics of the waste/material or in the process <br /> generating the waste/material. Customer agrees to pay the above <br /> charges and to be hound by the terms and conditions (:) set forth in <br /> ta) the General Terms and Conditions provided separately to Customer <br /> or ib) any SM agreement signed by Customer and SK, and (2) <br /> incorporated herein by reference. Unless otherwise indicated in the <br /> payment received section, SK is authorized to charge Customer's <br /> account for this transaction. If Customer fails to make payment when <br /> due, an amount equal to the lesser of (i) 1.5% per month 1184 per <br /> annum} or (ii) the maximum amount allowed by law, will be added to all <br /> unpaid amounts outstanding. Customer certifies that the individual <br /> signing this Service Acknowledgement is duly authorized to sign and <br />